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At least 163 records · Page 9Linked to original sources
PubMed1988

Adhesion-related variceal hemorrhage following sclerosis of esophageal varices.

A 78-year-old woman with portal hypertension had recurrent episodes of lower gastrointestinal hemorrhage two months after bleeding esophageal varices had been successfully treated with endoscopic injection sclerosis. Labeled red blood cell scans and mesenteric angiographic examination allowed a preoperative diagnosis of adhesion-related varices as the cause of bleeding. The problem was successfully treated by dividing the adhesion and resecting the involved small intestine.

Aged↗
PubMed1992

Who benefits from endoscopic sclerotherapy of bleeding oesophageal varices? Proposal for differential indications. The Copenhagen Esophageal Varices Sclerotherapy Project.

The value of early sclerotherapy for variceal haemorrhage remains unsettled, possibly because the treatment may be beneficial to some patients and harmful to others. On the basis of a randomized clinical trial of sclerotherapy in 187 patients presenting with their first variceal haemorrhage, we examined the relationship between clinical, endoscopic and biochemical characteristics at admission and the treatment effect on mortality. As previously published, sclerotherapy had no overall effect on the very high mortality during the first 6 weeks (47%), but thereafter the mortality and risk of rebleeding were reduced. The analysis showed that in the 48% of the patients with disturbed consciousness and/or elevated plasma creatinine, sclerotherapy considerably increased short-term mortality, and this was not compensated for by increased long-term survival. Among patients without these characteristics, sclerotherapy reduced mortality in the 25% with ascites, but did not affect short-term mortality in the 27% without. Sclerotherapy significantly improved the long-term survival of these patients. The results suggest that sclerotherapy should not be used in patients with disturbed cerebral or renal function, whereas it may be beneficial in patients without these characteristics.

Adult↗
PubMed1994

Optimized analysis of recurrent bleeding and death in patients with cirrhosis and esophageal varices. Copenhagen Esophageal Varices Sclerotherapy Project.

The course of cirrhosis after the first episode of variceal bleeding is characterized by recurrent episodes of bleeding and bleeding-free periods, with each new stage being associated with an initially high mortality rate. Analysis of the course of this disease is usually based on traditional survival models measuring observation time from admission to hospital. This approach cannot provide valid answers to the following clinically relevant questions: 1) what is the risk of death while bleeding? 2) what is the risk of continuing bleeding? 3) what is the risk of death after bleeding has stopped? 4) what is the risk of a new bleeding episode among those who remain alive and do not bleed? and 5) do the answers to the former four questions depend on the number of previous bleeding episodes or on the time since the first episode? These questions may be addressed using the multistage, competing risks model presented here. By measuring time from the start of each new bleeding or bleeding-free period, this model synchronizes the patients with respect to disease development and, hence, to level of the rate of new clinical events. This reduces the heterogeneity of risk levels in the patient group at any given time. In an analysis of 94 patients with cirrhosis admitted for their first episode of variceal bleeding, we estimated the mortality rates during bleeding and without current bleeding, the rate of cessation of bleeding and the rate of rebleeding. The influence of number of previous rebleedings and of the time since the first bleeding was examined using a Cox regression model for competing risks.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease Progression↗
PubMed1998

Analysis of the treatment effect on recurrent bleeding and death in patients with cirrhosis and esophageal varices: multistage competing-risks model compared to conventional methods. The Copenhagen Esophageal Varices Sclerotherapy Project.

BACKGROUND/AIMS: Multiple recurrences of bleeding with high mortality in cirrhosis with esophageal varices have been inadequately analyzed in previous trials. We propose analysis by the multistage competing-risks model, specifying the effect on overall mortality as an effect on mortality during bleeding, rate of cessation of bleeding, mortality rate without bleeding, and rate of rebleeding. METHODS: The Copenhagen Esophageal Varices Project enrolled patients after first bleeding and randomized 94 to usual treatment and 93 to sclerotherapy as supplement. During 9-52 months of follow-up, rebleeding occurred in 49 and 42, and death in 68 and 60 patients, respectively. The proportional hazards regression model (Cox model) was used for reanalysis both by the multistage competing-risks model and by conventional analysis for overall mortality and rate of first rebleeding. In the multistage model, time zero was at entry to any new disease stage, of which the first four were analyzed - two bleeding stages and two bleeding-free stages. RESULTS: The conventional analysis showed a reduction of overall mortality rate in the sclerotherapy group of borderline significance, but no effect on rate of rebleeding. The multistage model indicated that sclerotherapy reduced the rate of rebleeding late in the disease course, and particularly after the first rebleeding. Rate of cessation of bleeding and mortality rates during bleeding and without bleeding were not affected by sclerotherapy. CONCLUSIONS: Conventional analysis may give misleading conclusions, which might be avoided by applying the multistage model. The effect of sclerotherapy on overall mortality may be ascribed entirely to the reduced rate of rebleeding.

Denmark↗
PubMed1984

Sclerotherapy of oesophageal varices after variceal haemorrhage.

Fifty-six patients with recent variceal haemorrhage were studied in a trial of repeated injection sclerotherapy through the flexible oesophagoscope, with a mean follow-up of 15.2 months (1-39). Twenty-five patients (45%) did not suffer further bleedings. The risk of bleeding per patient-month of follow-up decreased significantly (p less than 0.05) after starting therapy, in all groups of cirrhosis, classified according to Child's criteria. Mortality during the study period was 39% (19.6% due to recurrence of variceal bleeding). The main complications of the procedure were the development of oesophageal wall ulcerations and oesophageal stricture.

Adolescent↗
PubMed1987

[Effect of glycylpressin on pressure in esophageal varices in patients with liver cirrhosis and previous hemorrhaging varices].

In 15 patients with the history of bleeding from esophageal varices, confirmed cirrhosis of the liver (Child A) and esophageal varices (grade II, 2; grade III, 11; and grade IV, 2 patients) esophageal intravariceal pressures were endoscopically measured before and 10 min after intravenous administration of 1 mg glycylpressin. Pressures fell in the patients without previous sclerotherapy from 21.8 +/- 2.8 to 19.0 +/- 1.9 mm Hg (not significant), in those previously sclerosed from 18.0 +/- 1.4 to 14.5 +/- 1.0 mm Hg (p less than 0.05). In two of the non-sclerosed patients and one after sclerotherapy no change of pressure was recorded. The results indicate that glycylpressin has a relatively minor and uncertain effect on esophageal intravariceal pressure. In view of the possible side effects of the drug the indications for its use should be carefully weighed.

Adult↗
PubMed1993

Splenic vein obstruction due to a solitary echinococcal splenic cyst, resulting in gastric fundus varices: an unusual cause of variceal bleeding.

A 27-year old female patient, born and living in Morocco, suffered from severe variceal bleeding and weight loss. Eventually a diagnosis of gastric fundus varices was made supposedly resulting from partial obstruction of the splenic vein and collateral blood flow via the short gastric veins. Splenectomy was proposed. Peroperatively it became apparent that a solitary ecchinococcal cyst in the hilus of the spleen obstructed the blood flow in the splenic vein. The cyst, the spleen, and part of the pancreatic tail were removed. After splenectomy bleeding did not recur.

Adult↗
PubMed1994

Gastric endoscopic features in patients with liver cirrhosis: correlation with esophageal varices, intra-variceal pressure, and liver dysfunction.

This study was aimed at evaluating the gastric endoscopic features in patients with liver cirrhosis and at assessing whether endoscopic findings correlated with the severity of portal hypertension and of the underlying liver disease. We studied 394 cirrhotic patients and 110 controls. Prevalence of a mosaic-like pattern of the gastric mucosa was significantly higher in cirrhotics than controls (80.5 vs. 0.9%; p < 0.001). Red spots of the gastric mucosa were found in 8.1% of cirrhotic patients and in none of the control subjects. Erosions and petechiae were found in 14.5 and 5.4% of the control population, but their prevalence was significantly higher in cirrhotics (28.7 and 12.7%, respectively; p < 0.05). Severity of the mosaic-like pattern as well as the presence of red spots were closely related to the size and hemorrhagic risk of esophageal varices and to the presence of fundic varices. Also, severe mosaic-like patterns were found more frequently in patients with severe impairment of liver function, as assessed by the Child-Pugh's criteria. Furthermore, the mosaic-like pattern was more severe in cirrhotic patients with a higher degree of portal hypertension as indirectly assessed by measurement of esophageal intravariceal pressure. In conclusion, (1) a mosaic-like pattern and red spots of the gastric mucosa are the only specific signs of congestive gastropathy in liver cirrhosis, and (2) the severity of the mosaic-like pattern correlates with the severity of liver dysfunction and of portal hypertension.

Adult↗
PubMed1999

Short- and long-term results of endoscopic variceal ligation for esophageal varices compared with injection sclerotherapy.

We assessed the efficacy and safety of endoscopic therapy for esophageal varices in Japanese patients comparing the results of ligation therapy performed in 101 patients with those of sclerotherapy with paravariceal injection of polidocanol in 40 patients. Both therapies were effective in controlling active hemorrhages. Hemostasis rates at the first endoscopic session were 100% in both groups and rebleeding rates were 40.0% in the sclerotherapy and 29.6% in the ligation group. Variceal eradication was achieved equally in both groups in approximately 90% of the patients. However, the ligation achieved eradication more quickly in fewer endoscopic sessions than did the sclerotherapy (mean; 2.1 vs. 3.7 sessions, P < 0.01). Complications such as rebleeding and intramural hematomas were less common in the ligation group. These results indicate some advantages of the ligation over the sclerotherapy. A disadvantage of the ligation therapy is that recurrence occurs more quickly than in the sclerotherapy, although the difference was not statistically significant.

Endoscopy↗
PubMed1984

[Hemorrhaging esophageal varices--Drug therapy and endoscopic sclerosing of varices].

Acute bleeding from esophageal varices is complicated by a mortality rate of 30-80%, which is reduced by sclerosing therapy to 20-38%. Sclerosing therapy also prevents recurrent bleeds, long-term survival rate seems not to be improved significantly. The decision to shunt procedures after recompensation of liver function is still discussed controversially .

Acute Disease↗